Framingham Heart Study

Framingham Heart Study, long-term research project developed to identify risk factors of cardiovascular disease, the findings of which had far-reaching impacts on medicine. Indeed, much common knowledge about heart disease—including the effects of smoking, diet, and exercise—can be traced to the Framingham study. The study’s findings further emphasized the need for preventing, detecting, and treating risk factors of cardiovascular disease in their earliest stages.

The Framingham Heart Study began in 1948. It was named for Framingham, a town in eastern Massachusetts that had been selected as the site of the study. The project was initiated under the direction of the National Heart Institute, which was newly established in 1948 (renamed the National Heart, Lung, and Blood Institute [NHLBI] in 1976). From 1971, through a contract with the institute, the study was carried out in collaboration with the Boston University School of Medicine.

Study cohorts

The Framingham study was designed to track health information on men and women who initially did not show signs of heart disease. The original cohort (study group) included two-thirds of the adult population (more than 5,200 residents) of Framingham, with ages ranging from 30 to 62 years. Every two years people enrolled in the study submitted to medical tests and answered detailed questions about their lifestyle. Over the course of the study, researchers kept records of which individuals developed heart disease and which did not, and they studied the connections between disease and the data that had been collected.

In 1971 more than 5,120 new recruits, referred to as the Offspring Cohort, were added to the study; the cohort was made up of adult children of individuals in the original study group and their spouses. In 2001 a Third Generation Cohort, consisting of individuals who had at least one parent in the Offspring Cohort, was added. From the 1990s the study also included Omni Cohorts, which consisted of minority individuals. The original Omni Cohort included individuals living in the Framingham community, with later cohorts including individuals both related and unrelated to the initial participants.

Findings and impacts

The findings of the Framingham Heart Study produced a revolution in preventive cardiovascular medicine and greatly influenced scientists’ understanding of the origins of heart disease. Numerous research papers based on the study’s data were published in the scientific literature, and the study inspired clinical trials that were crucial to advancing the management of heart disease and its prevention. The Framingham study also provided data that were used for the investigation of cancer, stroke, osteoporosis, arthritis, dementia, diabetes mellitus, and eye disease as well as for the study of inheritance and genetic patterns of common diseases.

Information gained from analyses of the Framingham cohorts changed the views of the scientific community about heart disease. For instance, before the study most physicians believed that atherosclerosis was an inherent part of the aging process such that blood pressure would be expected to increase with age. The Framingham data suggested otherwise, that atherosclerosis is an arterial abnormality rather than a normal part of aging.

The Framingham study also solidified the relationship between high cholesterol levels and increased risk of cardiovascular disease. The data revealed a strong positive association between low-density lipoprotein (LDL) cholesterol and coronary heart disease and uncovered the protective effect of high-density lipoproteins (HDLs). Researchers were also able to use the data to identify genes that regulate cholesterol metabolism, facilitating the discovery of mechanisms by which genes contribute to common metabolic disorders, including obesity, hypertension (high blood pressure), and diabetes. The study enabled researchers to create a DNA library from blood samples collected from more than 5,000 individuals of two different generations; the DNA library aided the study of disease inheritance and the discovery of genes associated with disease.

In addition, research on blood pressure based on the Framingham cohorts dispelled misconceptions. Before the Framingham study, it was thought that women and the elderly tolerated high blood pressure relatively well, with little consequence on cardiovascular health. However, after analyzing the Framingham data, researchers found no evidence to support the contention that the elderly fare better than younger persons at a given degree of hypertension. Nor did the data support the idea that women with high blood pressure are at lower risk of cardiovascular disease compared with their male counterparts.

Moreover, Framingham researchers found that an unhealthy diet, sedentary living, and weight gain increase the risk of cardiovascular disease and influence the progression and severity of cardiovascular problems. They also proved that smokers are at increased risk of myocardial infarction (heart attack) and sudden death and that those risks are related to the number of cigarettes smoked each day. Smoking cessation, on the other hand, was found to halve the risk of myocardial infarction. Other studies derived from Framingham demonstrated that even low levels of exercise can have protective effects on the heart.